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Referrals and Authorizations

Improved outcome. Increased revenue.

Synova helps your team achieve quality scores >99% with its advanced referral management services.

TAT upto
5
days ahead
100
k+
cases processed
STAT processing within
8
hr
TAT upto
5
days ahead
100
k+
cases processed
STAT processing within
8
hr
TAT upto
5
days ahead
100
k+
cases processed
STAT processing within
8
hr
TAT upto
5
days ahead
100
k+
cases processed
STAT processing within
8
hr
What we offer

Referrals and Authorizations

Navigating the healthcare system involves two key processes: referrals and prior authorization. Referral systems streamline communication between PCPs and specialists for a smooth care journey. Prior authorization ensures cost control by requiring pre-approval from insurers for specific services before delivery. Both optimize patient care and financial management.

Timely Patient Referral

Synova aims at handling referrals efficiently and effectively to ensure that patients receive the necessary care while maximizing revenue and minimizing delays or denials. Our RCM team verifies insurance coverage, checks for referral and authorization requirements, and submits authorization requests to the insurance company as needed.

helps with

  • Reducing delays in patient care
  • Maximizing revenue
  • Minimizing claim denials

Smooth Prior-Authorization

Synova provides a strategic cost-control process where healthcare providers secure prior approval from a healthcare plan before delivering services.

helps with

  • Reducing claim denials and rejections
  • Improving revenue capture
  • Enhancing patient care coordination

Transparent System Leading to High Quality Metrics

The referrals and authorization modules of Synova are highly transparent. This leads to a seamless flow of information, clear communication, and trust among the members, thereby improving the quality of metrics.

helps with

  • Ensuring seamless information flow
  • Enhancing communication and trust
  • Improving quality metrics

Find what’s Right for you

Discover how Synova can unlock value through our customized solutions across all stages of your healthcare journey. From optimizing operations to enhancing patient care, we're here to support your journey toward excellence in healthcare delivery.

Challenges We Solve

Choosing Referrals and Authorization

Reduce Delays and Frustration

Prior authorization processes can be confusing and time-consuming, leading to delays and frustration for both patients and providers. Synova's advanced technology and software modules streamline the process, minimizing confusion and expediting approvals.

Ensure Clear Communication

Ineffective communication between healthcare providers, RCM teams, patients, and insurance companies can lead to several pitfalls. Synova bridges this gap by implementing secure messaging platforms, standardizing communication protocols and templates, and providing training on effective communication practices.

Minimize Denial Rates with Evidence-based Support

Incomplete or incorrect submissions can lead to claim denials. We back you with clinical evidence, significantly increasing the chances of approval and reducing the number of denials.

Measurable Impact

TAT upto
5
days ahead
STAT processing within
8
hrs
100
K
cases processed
Customized Solutions

Designed for your Requirements

Our service solutions streamline operations, enhance patient engagement, and integrate advanced clinical support technologies, tailored to meet your specific needs with efficiency and excellence.

Improved Patient Access to Specialized Care

Synova helps generate referrals and pre-authorization through calls and portals, ensuring efficient and timely processing of referrals and pre-authorization, minimizing delays in accessing necessary healthcare services.

Enhanced Patient Satisfaction

Improved handling of all patient referrals resulting in patient satisfaction, improved access to care, and increased revenue.

Improved Outcomes

Efficient referral and authorization management is important to ensure timely access to specialized services, avoid reimbursement delays, and optimize both patient outcomes and financial performance, leading to improved patient care and reduced revenue leakage.

Revenue Optimization and Cost Control

Prior authorization helps control healthcare costs by ensuring that services are medically necessary and appropriate before they are performed, reducing unnecessary utilization and associated expenses. This further reduces the chances of claim denials.

Improved Compliance

Synova promotes timely patient referral, ensuring compliance by systematic follow-ups, closing gaps in care, which are especially challenging in large, complex delivery systems.

how it works

How Synova Is Integrated with your Business

Synova integrates seamlessly into business operations by deploying advanced technologies and specialized expertise in healthcare operations management. This integration optimizes processes, enhances efficiency, and ensures compliance, supporting sustainable growth and improved patient care outcomes.

01

Identification of Need

The referral process begins when a patient visits a primary care provider (PCP) or a healthcare specialist determines the need for specialized care, services, or consultations. 

02

Referral Order

If a referral is necessary, the provider generates a referral order in the electronic health record (EHR) system. The referral order includes details such as the reason for referral, the specialist or facility being referred to, any relevant medical information, and the urgency of the referral.

03

Authorization Process

Upon receiving the referral order, our team verifies the patient's insurance coverage and checks for referral and authorization requirements. If the services or procedures require prior authorization from the insurance company, we submit an authorization request along with supporting documentation.

04

Approval or Denial

The insurance company reviews the authorization request, assesses the medical necessity, and evaluates if the requested services meet coverage criteria. If approved, the insurance company provides authorization for the services, specifying any conditions, limitations, or requirements.

frequently asked questions

All your Doubts Resolved

What is Referral?

Referral is a process of directing the patient to a specialized physician (specialist)/facility by the primary care physician (PCP) for definitive treatment. An efficient referral management process can significantly increase patient retention.

What is the difference between a referral and an authorization?

A referral is a formal recommendation from a primary care provider (PCP) to a specialist or another healthcare provider for further evaluation or treatment. It acts as a communication tool between providers to ensure coordinated patient care.

What is Synova’s Referral Management System?

Synova’s referral management system is a unique and powerful tool for health providers to keep track of their patient referrals throughout the care continuum. Its main goal is to improve and streamline communication among primary care physicians, specialists, and patients.

How can automation help in managing referrals and authorizations?

Synova’s automation significantly streamlines the referrals and authorizations process by reducing manual entry errors and speeding up the approval process. It checks payer requirements, submit requests electronically, and track the status of requests in real-time.

What is Prior Authorization?

Prior authorization (also known as pre-authorization) refers to the process of getting a medical service(s) authorized by the insurance payer. It is a cost-control process by which physicians and healthcare providers obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

What role does communication play in the referrals and authorization process?

Effective communication is vital for ensuring that all parties involved—healthcare providers, patients, and payers—are informed about the status and requirements of referrals and authorizations.

Is Referrals and Pre Authorization mandatory?

Yes, Referrals and Pre Authorization enable the insurance companies to pay for the services renders. It also allows the patients to attain get high-quality care.

Your Process, Our Technology

Building a Partnership grounded in trust and transparency.

When we build solutions with healthcare organizations like yours, it significantly reduces development and adoption times. We work as partners to solve problems and unlock tangible value.

Accelerated Outcomes
Partnering with Synova reduces development and adoption times, expediting the delivery of efficient revenue cycle solutions.
Value-driven Collaboration
By combining healthcare organizations’ patient-focused experience with Synova’s expertise, our partnership unlocks tangible value and fosters innovation.
Compliance Assurance
Collaborating with Synova ensures solutions are developed to meet industry standards and regulations, fostering trust and delivering high-quality, compliant outcomes.

Bring a change to your Healthcare Operations

A partnership with Synova gives you an inherent:

Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.

Sense of ownership and commitment towards providing value.

Focus on speed, accuracy, efficiency, and optimal outcomes.

Sense of security and transparency through periodic reporting and actionable insights.

Connect with our experts for a quick analysis and possibilities.

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